While no one wins the White House on the cheap, Trump was not the candidate of big-money donors–or big-money period. His Republican opponents (along with some highly motivated super PACs) spent vastly more than he did in the primaries. And while Trump happily sucked up to billionaires like Robert and Rebekah Mercer for help in the general, his money machine was nothing compared to Clinton’s. Plenty of GOP money-men opted to sit out this presidential battle and channel their money into down ballot races.

Nor did Trump rely on saturation TV advertising or obsessive polling or cutting-edge data analytics. In fact, he gave the finger to high-priced strategists, ad-men, pollsters, and all those other shifty political pros that churn out the slick, poll-tested candidates that Americans love to hate. (For a scathing look at the entire consulting class, see Molly Ball’s piece[2] from October. ) Just ask Jeb Bush (or Marco Rubio or Ted Cruz) whether the red team’s crack strategists were worth the money this cycle.

More:

Trump did not win the endorsements of powerful media outlets or sparkly celebrities–or much of anyone for that matter. And more than any race in modern memory, his election was a victory of the grassroots over the political establishment. Forget the DNC’s minor machinations in boosting Clinton over Bernie Sanders; arguably never have a party’s leaders been as intent on derailing the chosen champion of the base as the GOP was when it came to Trump. Even those who, out of either cowardice or team loyalty, didn’t outright reject Trump made it clear they were holding their noses where he was concerned. (Looking at you, Paul Ryan.)

As for the substance of the election: The media exerted little to no control over Trump’s messaging. This is not to say that political journalists gave him a free ride. Especially as the race wore on, reporters dug into the endless controversies swirling around the nominee and kept a spotlight on his steady stream of verbal atrocities. But from the 30,000-foot perspective, Trump worked the media, both social and traditional, like the master carnival barker he is. He followed a direct-to-consumer sales model—his true nature graphically on display–kicking the usual middle-men to the curb.

Read the whole thing. [1] If you don’t know her work, Cottle is a liberal, and the last thing from a Trump defender you would expect. But she’s honest here. Given the facts she details, if Trump were a man of the left, he would be hailed by the media as a hero who fired his photon torpedoes right into the Empire’s thermal exhaust port for the win.

I find the insistence of many liberals now that Clinton won the popular vote to be annoying. Yeah, she did, and maybe the Electoral College needs scrapping, I dunno. The much more important point is that Hillary Clinton, the very embodiment of Establishment Washington, lost the presidency to Donald Trump. Donald Trump! That’s a message that shakes both the Democratic Party and the establishment of the Republican Party to their cores. Whether you like Trump or not, you have to admit that his was a breathtaking achievement.

Anne,
IMO (speaking as one of the never-Hillary men you reference), voters neither voted against her nor failed to turn out and vote for Hillary because of “demonization” over 25 years or some “vague bias”. No, both rejection and lack of enthusiasm and support for HRC were for many very good reasons. First, she offered little positive or inspiring; her main message was ‘vote for me because DJT and his supporters are so deplorable, etc. Second, I am of a household with 52 years in federal legal offices. We could not get over her shockingly poor decisions, deceits, and lies re her email servers and destroying federal records–sought by law under the FOIA, Congressional subpoena, and FBI investigate! Third, Hillary’s last 6-8 years have been revealing and very unbecoming. Her performance as Sec of State is, IMO, dismal at best. Arguably she is more a hawk and bent on endless foreign interventions than our unknown Dem-like Pres-elect. Say what one will about any goods done by their charitable foundation, the audit by Simpson Thatcher showed some real issues, and their mixing of her State staff and interests with those of the foundation and her husband also seems brazen. The public corruption investigation continues, does it not? Why did she not keep her pledge to Pres Obama to keep those interests entirely unmixed? Did not Hillary and Bill after leaving the WH “dead broke” overplay the power and popularity that public trust gave them?

Franklin Evans,

Yes, the ACA brought federally-subsided health insurance to 1000s of people previously uninsured. Couldn’t Congress and Obama have accomplished this without the atrocious monster law and absolutely partisan process and the loss of so many folks’ policies and doctors that make the ACA widely and intractably unpopular? A few months ago, the best figures I found showed we still have 25-30 million uninsured. I recall the pre-Obamacare sales pitch was that we need to cover 30 or 40 million uninsured. IMO, Obamacare and its passage was a disaster that left a WA big government bad taste and stench with many voters. Bill Clinton called the ACA “crazy.” Indeed.

[3]

[4]

#2 Comment By Chris 1 On November 26, 2016 @ 10:50 pm

Why commit fraud unless it’s to elect your candidate?

Here’s how devious liberals are: They fix elections so that they lose, and then challenge the outcome as if they had nothing to do with it, just to make conservatives look bad.

#3 Comment By Nelson On November 26, 2016 @ 11:08 pm

A person who mischaracterizes Mexicans looking for a better way of life as “rapists” is no hero, regardless of political party.

#4 Comment By Winston On November 26, 2016 @ 11:29 pm

It was not his achievement that Hillary depressed the vote. It is embarrassing how few Americans voted for her or him. Almost 47% stayed home!

#5 Comment By Heartright On November 27, 2016 @ 2:51 am

Julian Massage, of course,is a much more reliable source than anyone who stoops to supporting Clinton.

Oh, TYT have nailed the lies of the Clinton-bots so many times.

#6 Comment By Heartright On November 27, 2016 @ 2:52 am

Assange. Spellcheck. ?

#7 Comment By Fran Macadam On November 27, 2016 @ 3:22 am

“Re: The head of WikiLeaks has said the emails did NOT come from Russia.

“An Julian Assange is a credible source?”

Not a single document has been shown to have been altered or false from their source in the suppressed email server contents; the excuse for not showing where the WikiLeaks documents are in error as asserted has been met with the evasion that they have no interest in either reading or discussing them.

They could easily point out even one of those from the WikiLeaks that had been altered; that it has not been done is simple mendacity.

#8 Comment By Fran Macadam On November 27, 2016 @ 3:40 am

“A person who mischaracterizes Mexicans looking for a better way of life as ‘rapists’ is no hero, regardless of political party.”

Of course, this is not what he said, even though it keeps getting repeated, so often that through constant repetition it is hoped that people who don’t check will think it is true.

In reality, he said that there are lawbreakers, including serious criminals, among those who avoid the legal border crossings and criminal checks in place. Even those who have committed no previous serious crime have decided to break the laws that most of the rest of us follow. I suppose you don’t know that the “coyotes” themselves have robbed, assaulted and raped those that they illegally lead across the desert, often abandoning them where they perish.

Also, it remains true that all lawbreakers, whether minor or major, including those who engage in drugs, weapons, contraband and human trafficking, are only looking for a better way of life for themselves, and to advantage themselves. Thieves and robbers will tell you as much, and even rapists will justify their need to satisfy their desires.

Illegal immigration isn’t good for either the host country, nor the exploited who are smuggled in, who must live in the shadows without protection and have to break numerous laws to get the reduced pay for their labor.

#9 Comment By Heartright On November 27, 2016 @ 6:46 am

[5]

This is what the liberals do not get: rejection of LIBERAL values is not a right wing thing, it is not about misogyny, it is not about racism.

It is about a total rejection of LIBERAL values throughout the Western world.

It can be headed from the left,it can be done from the right, and the message is the same.
Liberal ideals stand rejected, and those who cling to them will just have to face the music.

#10 Comment By JonF On November 27, 2016 @ 7:51 am

Re: For instance, I think he has a mandate to stall the TPP, because he wouldn’t have won unless he stood against it.

Agree– since Hillary Clinton turned against it to. As I have said before trade is one area where deals can be cut and a new bipartisan consensus is possible.

I think he has a mandate to do health care reforms not because of election results, but because the public consensus has turned against Obamacare to the point that even Democrats agree things aren’t working.

The ACA needs some fixes, but a complete repeal and a return to the status quo ante? I don’t think that’s what Trump was elected for. Many features of the ACA continue to poll very favorably. To borrow a slogan from the 90s, Mend it, don’t end it.

Re: I didn’t think he had a mandate on things like health care simply because I don’t think the voters viewed the election as a referendum in support of one health care plan vs. another.

In 2008 the design of what would become the ACA in its broad outline was very much publicized as a campaign issue– in fact it was one of the top issues. It’s not as if there was some sort of bait and switch, as in 2004-05 when the newly reelected Bush out of no where proposed a Social Security privatization plan which no one had been talking about during the election (and promptly got his comeuppance on it as a result). If people did not know what they were voting for on healthcare in 2008 then maybe it really is true that no one ever goes broke betting against the intelligence of the American people.

In fact, just the reverse. The Articles of Confederation describes the states as “sovereign,” and that was the problem. Hence we have the Constitution–“US Government 2.0”–which nowhere uses the term.

Not only the name, but the conditions, of sovereignty are rejected in Article vi, where after defining the laws of the US as the supreme law of the land, the founders specify that “the judges in every state shall be bound thereby, anything in the Constitution or laws of any State to the contrary notwithstanding.”

As for “diversity,” I suspect we’re reading a 21st c. value back into the 18th.

#12 Comment By Franklin Evans On November 27, 2016 @ 9:04 am

Downhill:

It would take a long treatise to explain some of the details, and I don’t like being credentialed by others, so I’ll just mention that I followed insurance statistics professionally for nearly two decades, I have a solid grounding in actuarial science, and the short answer to your skepticism lies in my citation of for-profit pressures. You can research that, though not easily.

I shy away from Politico. The Bloomberg article has some very good facts (though not sufficiently expanded). I’ll try very hard to be brief.

The notion that people get to choose to not buy health insurance is a symptom, not a cause. Universal, socialized insurance coverage has no such problem. Everyone is covered, period. The cause, amongst several, is the market. If companies’ first priority is profit, they are going to actively (some aggressively) manipulate their market share according to profit incentives.

Item: the younger insureds are, the lower their premiums will be, and the less will be available for reserves. The longer they wait, the higher their premiums will be when they do decide to start paying them.

Item: claims are routinely denied on no better criteria than they cut into the profit margin. That looks cynical (and deserves it), but it is a fact of business.

People don’t like to acknowledge the fundamental arithmetic of insurance. If risk is shared amongst a very large number of people, the individual premiums are smaller. They fail to understand that they are purchasing coverage for the possibility of needing to make a claim. Unless they make a claim, they are then encouraged to believe that their money is being wasted, that they are paying for the claims of others.

The first flaw of ACA is that it doesn’t do anything to mitigate the profit pressures. Nearly everything else derives from that. Further, ACA by design permits carriers to either game the system for profit, or remove their coverage from areas because they can no longer expect to profit from them.

In short, nothing short of prohibiting the making of profit from health care can address the many shortcomings of the current system. Your research can start with the first not-for-profit business model, Health Maintenance Organization, since genericized and corrupted by profit-making to “hmo”.

#13 Comment By mrscracker On November 27, 2016 @ 9:55 am

Franklin,
I’m a bit confused about the perspective of your theatrical friend. Cynicism was the opposite message of the Music Man as I remember.
Professor Harold Hill was a conman for sure, but in the play he used music as a device to bring warring town factions together and build self confidence in others. I thought the moral was about believing in yourself and pursuing your dreams.
Making”Mason City” great again.
🙂

#14 Comment By mrscracker On November 27, 2016 @ 10:13 am

PS,
Thank you for sharing that analogy about Trump/The Music Man.
It’s actually very good but perhaps not in the sense your friend intended. At least from my view point.
It never was really about Trump or Professor Harold Hill. It was about folks taking their message to heart and making it real.
I hope that we have a similar happy ending after the inauguration. It’s not a given as it would be in a 1950s musical.

#15 Comment By Franklin Evans On November 27, 2016 @ 10:54 am

Mrs. C.: I am a student of theater, my friend and others are my teachers and mentors. I believe most (if not all) of them would say how the play speaks to you is what’s important, not how others believe you should hear it. I really like this bit of wisdom from the artist’s POV:

“Art is not what you see, but what you make others see.” Edgar Degas

#16 Comment By grumpy realist On November 27, 2016 @ 2:38 pm

Well, now that Paul Ryan is going for his Randian fantasies of privatizing Medicare, getting rid of food stamps and probably Social Security as well, what are Trump’s Chumps going to do when their beloved “social support systems” get trashed and they get thrown out on their ears with no support and even less money?

You really think The Donald is going to protect you? Ho ho ho…

#17 Comment By Siarlys Jenkins On November 27, 2016 @ 3:16 pm

It can be headed from the left,it can be done from the right, and the message is the same.
Liberal ideals stand rejected, and those who cling to them will just have to face the music.

It makes a great deal of difference. The message is not the same. Rejection of liberal values is a negation. What the positive message is, we may differ on significantly.

If the election results for Trump were hacked, how do we know the recounting to put Hilllary in isn’t also a hack?

The recount is hand counting paper ballots, at least in most jurisdictions in Wisconsin. Machines differ from municipality to municipality, let alone county to county, but in Milwaukee, the results from each machine are sent by wireless signal from the polling place the the election commission offices, a thumb drive with the electronic record is physically transported to commission staff, a physical tape that prints out the results on paper is also transported (two copies — one showing that the results were zero just before the polls opened), and the paper ballots scanned by the machine are packed in a sealed bag, to be available for recount and comparison if needed.
For instance, certain brands of “conservatives” reject liberal values because liberals efforts to beguile the working class into believing capitalism is good for them get in the way of brutal repressive measures that keep the working classes cowed and submissive. While, from a revolutionary socialist point of view, those same liberal measures get in the way of the working class understanding that capitalism is the root problem. Of course the world and the motives for people to live, vote, eat, work, or rise up from time to time, are far more complex than any of those three points of view easily acknowledges.

Couldn’t Congress and Obama have accomplished this without the atrocious monster law and absolutely partisan process and the loss of so many folks’ policies and doctors that make the ACA widely and intractably unpopular?

There were, no doubt, many ways the ACA could have been done better. President Obama had before him the precedent that Hillary Clinton had chaired a commission that came up with what it considered a pristine well-organized plan, and every interest group in American used it for target practice. Therefore, he asked congress to send him a health care bill, and invited ever interest group in America to participate in crafting the bill. The result, predictably, was a camel — a horse designed by a committee. But, it had, barely, the support to pass, and sufficient private sector cooperation to go into effect.

The notion that the ACA ruined everyone else’s existing health care coverage is way overplayed. Before the ACA, premiums had been jumping by leaps and bounds. Before the ACA, insurance companies had been changing coverage every year in various ways. Before the ACA, employers had been trying to increase deductibles, narrow the range of coverage offered, put more share of cost for premiums onto employees, in order to save themselves money. All of a sudden, everything that happens is the fault of the ACA?

It is true however, that if you require a number of things to be covered by all policies, on and off the exchanges, then the cost will rise, because even a truly non-profit has to cover expenses. Franklin Evans has pointed out before the distinction between insurance (against unlikely but very expensive episodes) and pre-paid medical coverage, but it would be political suicide to make that clear in a congressional debate, much less an election campaign.

#18 Comment By Another Matt On November 27, 2016 @ 4:59 pm

Trump’s campaign was vague enough that his “mandate” will be vague as well. He ran on the last three administrations having been a “disaster” in every respect, so they could decide that anything is fair game.

#19 Comment By Heartright On November 27, 2016 @ 6:14 pm

My dear Siarlys, objectively speaking, ‘Make America great again’ contains more positive content than ‘vaffanculo!’
Probably Syriza has a more positive message, but, you know, it’s all Greek to me.
‘we turn the page’ and then what?

That is the problem of the Left. At this time, it does not have a coherent joint critique.
We observe the symptoms of the maladie, but have no consensus on the precise disease. ( Environment? Patriarchy? Globalism? TIPP? Imperialism? )

What we do have, however, is a towering rage against the morons who are leading us down the gardenpath.

There is a joke I am wont to tell since the Democalypse.

There was a Jewish millionaire who ran away from Germany to Russia in the days of the Molotov-Ribbentrop pact. He then claimed asylum because he was a Jew. The local KGB boss looked him over and said’ take this capitalist to the Gulag’.

Different diagnosis. Same solution. And with that in mind, the liberals will just have to face the music.

#20 Comment By Anna Duarte On November 27, 2016 @ 6:25 pm

Haven’t you heard the latest from Trump. Exclude illegal voters and he won the popular vote too.

I’m beginning to think he has dementia or something. His relationship to reality cannot be that unhinged, can it?

[NFR: I don’t think he has dementia, and yes, I think he really does have a tenuous relationship to reality. But here’s the thing: so do a *lot* of people, on both sides of the political spectrum. I’ll never forget the first time I had a conversation like this with a fellow conservative. I could not make her understand that we were not arguing about opinions, but demonstrable, objective facts. This was something to do with a policy of the George W. Bush administration. She kept saying that I could not really be a conservative, because no conservative would criticize the GOP president. Her next fallback was that whatever point I was arguing (I forget what it was now) was “just your opinion.” No, I said, this is fact. I remember quoting to her from PRESIDENT BUSH’S OWN STATEMENTS … but it did no good. She was seriously convinced that because this issue, whatever it was, put Bush in a bad light, then it could not possibly be true. She kept saying, over and over, “You’re entitled to your opinion, and I’m entitled to mine.” That made such an impression on me because it made me think that we really might be in a hell of a lot of trouble in this country, if people start to think that reality is what makes us feel good, facts be damned. — RD]

#21 Comment By Siarlys Jenkins On November 27, 2016 @ 8:00 pm

Heartright, when you learn to say “Make America Great Again” in Greek, do got back to us on what it all means.

Meantime, I recall that a little while before the election, Franklin Evans advocated that shredded cheese should be banned:

Make America grate again.

#22 Comment By VikingLS On November 27, 2016 @ 10:35 pm

@Grumpy

Flash forward to 2018.

Someone:Grumpy, remember when you said that Paul Ryan was going to gut Medicare, Socvial Security, and the Food Stamp Program, and then NONE of that happened?

Which kinda does make sense: from that moment onward the United States doubled down on hubris, and started going collectively batty.
Or maybe that is the wrong term, they went from loopy to psychotic.

#24 Comment By Franklin Evans On November 28, 2016 @ 10:55 am

Viking, I’ve been directly dealing with (first career, pension actuary) or reacting to (second and current career, software engineer for financial systems) federal regulations since 1976. The simple reality is that Congress is capable of anything out of political expediency, and while “gutting” is admittedly hyperbolic, significant and impactful changes are on the books for you to see.

Social Security is the longest running federal program to which Congress has been able to avoid making damaging changes. ERISA changed the entire face of retirement savings and planning — removing with the stroke of a presidential pen decades of employer abuse of pensions — and it took Congress about ten years to make significant changes to it that in hindsight were damaging to its original purposes.

Ask me “remember when you said” in two years. I’ll give you an honest answer.

#25 Comment By Another Matt On November 28, 2016 @ 11:16 am

Someone:Paul Ryan, remember when you said that you were going to gut Medicare, Social Security, and the Food Stamp Program, and then NONE of that happened?

Paul Ryan: No

#26 Comment By Jeremy Hickerson On November 28, 2016 @ 12:14 pm

Trump won it fair and square AND he bamboozled everybody.

#27 Comment By Brendan Sexton On November 28, 2016 @ 3:16 pm

Chris 1 said, “And those who listened to Trump figuratively rather than literally, who chanted “Lock her up,” or “Build the wall,” or “Tear it up” or whatever, are the real problem. They knew they were being lied to and loved it, because it was emotionally satisfying.

This, it seems to me is real problem, it is a problem of popular democracy, not just of this election. The Founding Fathers anticipated this, and their preventive device was to invent the Electoral College…..oy….But if that doesn’t work to counter this problem, what will? I don’t want this discussion to disappear after the votes are counted and recounted–I think it is a serious problem. It’s not just that demagogues distort the process and thwart the intentions of our Founders, it’s that a demagogue may seize power in the richest and most powerful nuclear nation on Earth.
Anyone who thinks arguing over emails or over horribly offensive language is more important than this is in denial. We are about to see just how bad this kind of thing can get. We will survive in the end–I don’t truck with the doomsayers who go too far in predicting nightmares–but there will be harm done. Don’t doubt it for a minute.

#28 Comment By Logan On November 28, 2016 @ 3:45 pm

I rarely comment as usually all viewpoints are put forth in a thoughtful, reasoned manner. But, the notion we should throw out the electoral college and its underlying principle of federalism is beyond me . . . sigh.

#29 Comment By VikingLS On November 28, 2016 @ 5:14 pm

@Another Matt

I expect that to be true.

@Franklin Evans

I was addressing Grumpy’s rather flip comment. Trumps’s going to let Ryan gut entitlements? The senate is going to? She knows that how?

If you had posted something I would have expected it to be supported and thought out, Grumpy? Not when it’s not about science.

#30 Comment By Rik Blumenthal On November 28, 2016 @ 7:37 pm

Photon torpedos are Star Trek.
The Death Star is Star Wars.
They are not the same.

I haven’t been able to figure out why Trump wouldn’t just go along with Ryan’s plans. He doesn’t seem to care one way or another. The main question will be whether or not we continue to have a filibuster.

Whether he should be or will be a “hero” for anyone remains to be seen. The odds are against it.

#33 Comment By Frankie On November 28, 2016 @ 10:37 pm

Proton torpedos were used to battle the Empire. Photon torpedos are used by the Federation. Please get your fandoms right 🙂

#34 Comment By Michael Ard On November 29, 2016 @ 6:27 am

Well, yes, Michelle Cottle. If Trump were a liberal, liberals would like him and applaud his achievement. But he’s not, so they don’t. Don’t see a lot of insight here.

Liberals should love the Electoral College because it gives them a distinct advantage before a single vote is cast. But never mind–let’s scrap it.

We probably need to take a hard look at California’s voter registration policies.

#35 Comment By VikingLS On November 29, 2016 @ 8:45 am

@another matt

It would be very unpopular with the people who elected him, who he’s going to need in 2020 if he wants to get reelected. He gains more leverage with the GOP by throwing Ryan under the bus, preferably after publicly humiliating him, than he gains by trying to make nice and go along with them.

#36 Comment By Jacksonian Grouch On November 29, 2016 @ 8:53 am

@Franklin Evans (posting November 27 @ 9:04 am).

this goes for Downhill and other commenters on this thread as well. I’m not versed in the particulars of ACA, so please consider the following request in that vein.

Franklin, it seems to me that your posting indicates the ACA could be fixed, while still providing a semblance of universal care, provided no profit can be had from health care. To me, that sounds like ACA was designed to fail from the start, by driving all for profit out of the field, thus leaving us with nothing but a single-payer model – complete, socialized medicine with no competition.

That is not a fix, sir – from where I stand, Man’s condition improves whereever there is competition, where participants in an industry strive to build the proverbial “better mousetrap”.

I ask you the following – let’s step back in time before ACA, back when private insurance was still the name of the game for coverage:

In your opinion, what could the following changes have accomplished in the previous environment that could have improved US Healthcare, and what do you think the impact of each would have been in both their individual effect and taken aa a collective whole?

> Tort Reform ((entirely anecdotal on my part here, not looking at total elimination, but seriously… can we afford to see more 100 million dollar lawsuits for a spilled up of McDonald’s coffee?))

> Getting FDA approval process for new drugs in line with other First State Economies ((I’ve read that Japan’s pharmacological costs from research to approval to final-cost to insured, is about 33% that of our own. If the Japanese can do it, why can’t we?))

Not a comprehensive list, of course, but these seem to be the big factors to me. Would greatly appreciate your thoughts/input on the above, as well as other factors you think might work.

Again, the above package is a “what-if”, to be considered in the context of what the world was like before ACA.

Why this exercise in counterfactuals? After all, one could easily brush my request aside as not dealing with the current reality, and I would not begrudge them that.

My motivation is driven by the belief that government largely caused this problem, this disruption of what amounts to about a third of our economy, of the money in all our pockets. And whenever government destroys something, history shows me that it is government that comes to the rescue.

Thus increasing government’s power over me, its reach into my life and the lives of my fellow citizens… ultimately diminishing my & our Liberty as it grows.

ie: Community Reinvestment Act and the 2008 Real Estate/market crash.

This is my belief, it’s what I see the govt doing now as ACA crashes. The very thing democrats denied back when they shoved obamacare down our throats: “…No, we do NOT want single-payer!…”, is what they are now suggesting would fix the system which crashes under its own weight.

As mentioned, I believe this to be true, but admit that I do not have all the facts completely – or at least, comprehensively – squared away on this. Which is why reach out to you for assistance; your comments impressed me as someone who would have more facts on this (…and will not use this in partisan manner ala Gruber…).

tx in advance for your input –

The JG

#37 Comment By Franklin Evans On November 29, 2016 @ 1:12 pm

The JG: I’m admiring your chosen handle.

ACA was a band-aid, says this erstwhile prisoner of federal regulations. The background is too extensive to do more than reference it or imply it, so I will ask of you a small leap of faith that I’m not misrepresenting it. I am offering my considered (as well as passionate) opinions based on my view of the facts, with my professional experience informing that view. I left a personal response to you for the end.

Health insurance per se has a long and complex history. If you search on “history of health insurance” you’ll find a 260-plus page book on the long and dry side, and a Wikipedia entry on the less tedious side (it has some very good links). The short summary, projecting my personal view on it that profiting from sick people is immoral, is that like any commodity health insurance evolved from group risk insurance to the multi-billion dollar industry we have on the simple concept that profit can be made whenever one can corner the market on a necessity of life.

There are some comparison points along the way. Consider the life of a family physician, whose own livelihood depended on the ability of his neighbors to pay for his services, cover the costs of his supplies and infrastructure (being why so many of them established their offices in their own homes, and their spouses were their unpaid assistants/nurses), and balance that against the need to not force his own patients to stop coming to him by bankrupting them.

The most important comparison point, however, is the several versions of “universal, socialized” health care in other countries, notably in Europe. The critical details, amongst several, are:

Item: their personal taxation rates are very much higher than the U.S., generating the revenue to pay for health care.

Item: their health care professionals make a good living from their services, and young people seek careers in health care out of choice and the expectation of having good lives of their own.

Item: the quality of health care in those countries is at least adequate, and in many cases competitive with the quality of U.S. health care.

Item: the sole pertinent difference is that in those countries, there’s no rarified class of people getting wealthy from it all.

If we are to assign blame to government — and I do not begrudge that exercise — compare it to the success of Social Security. It transformed a nation with the elderly cohorts in moderate to severe poverty — and a downward pressure towards bankruptcy for any families who tried to support them — to an expectation that upon retirement a person could at least subsist (and get health care from Medicare) and not depend on adult children who simply cannot afford to support them. The blame I’d assign, if you will, is that government failed to design and institute a health care program for all citizens, especially once the cost of such care passed the threshold to egregious risk of either bankruptcy or death should the need for it arise.

The health care industry is embedded in our society, and nothing short of egregious overhaul can transform it from a profit-making scheme to a delivery of critical services not dependent on the charity of others or the knife-edge balancing of professionals and institutions between accepting all patients who simply don’t have the money to pay them, and the risk of going bankrupt themselves.

The JG: Thus increasing government’s power over me, its reach into my life and the lives of my fellow citizens… ultimately diminishing my & our Liberty as it grows.

I respect that view, even though I consider it flawed. In this case, as has been true as well for child labor prohibitions, free public education for all, and national infrastructures like the Interstate highways, government “power” is over the ability for some to profit from those things, not over us citizens per se. I submit to you that this “power” is really a trade-off between your personal risk of bankruptcy or death, and an increase in the taxes the government takes from your income.

#38 Comment By Franklin Evans On November 29, 2016 @ 1:45 pm

Pertinent addendum: NPR and other news outlets are reporting on the effect Trump’s promise to abolish ACA will have on the costs to women for their particular health care needs, notably maternity. Even the NPR article fails to point out a simple fact of insurance: actuaries are required to calculate premiums for coherently defined groups, and when that definition creates a “separation”, as with between male and female, the premiums are going to be different. Maternity is a health care cost for women only. Life insurance, on the other hand, is routinely more expensive for men because actuaries see that the statistics show for nearly every age cohort that women have a longer life expectancy as a group.

This is not discrimination. This is the basic application of actuarial science.

#39 Comment By Siarlys Jenkins On November 29, 2016 @ 2:44 pm

Trump “gains more leverage with the GOP by throwing Ryan under the bus, preferably after publicly humiliating him, than he gains by trying to make nice and go along with them.”

???

I hope Trump has half the discernment Viking displays, but I’m not holding my breath. Ryan, the consummate opportunist, as soon as he saw Trump had been elected, and the GOP still had its congressional majorities, was certainly prostrating himself before the throne while assuming he (Ryan) would have the room to set and push through his own agenda. Will Trump have the inclination or motivation to do otherwise? That’s the $64,000 question.

#40 Comment By Jacksonian Grouch On November 29, 2016 @ 5:17 pm

@ Franklin Evans –

Tx for the response, getting a better understanding of this complex topic.

Moving further along, I see that you believe – and please correct me as I go along if I miss a point – the profit factor to be a negative, that you find it immoral. Fair enough; I do not defend the profit here for the mere sake of making money off the process. I place great weight on how Adam Smith so keenly and accurately reads Human Nature – when he speaks of self-interest, he speaks to us all, individual and incorporated alike. From this pearl of wisdom, which I trust even as I find in so many ways to be unpalatable, I deduce that many parties struggling for profit in a business, even within healthcare, is better for the overall body of insured population than would be a system that does not include it.

Ok, so you find the system as constructed to be immoral. How can it be fixed? More specifically, how can it be fixed via one of the 2 realistic pathways we have before us: (A) via more centralized control/coercive oppression from above (and I don’t mean God, either…); or (B) as a self-regulated fix that comes from the people, with minimal govt interference/only the necessary regulation?

I don’t think it can be (A) – and I don’t think you would see this as the solution, either. It must be the latter choice – but it can never thence be uniform, or clean of anything that might smack of immorality, even if the degree of morality in your opinion or of others who agree with you, would somehow improve. With freedom comes a great swath of possible outcomes; greatness as well as baseness; the highest form of altruism as well as the immoral.

I don’t see, sir, how the immoral could be cleansed from this picture. Not without it happening in one of the two paths mentioned above. Each with its own new set of unique challenges.

Another point, I recall finding online an article about charitable contributions from the American citizenry as compared to US Government international subsidies to all parties. Insofar as the US Government viz-a-viz other governments gives more money to other nations, the article noted that charity from Americans – to all causes, at home and abroad – was higher in total than that given away by the government.

So Charity does work – but it, too, can be swept away by the overbearing presence of government.

Tx, looking forward to your next entry!

The JG

PS: it’s a play on my nickname and my final rank as a retired Coastie… with a heavy emphasis on the Walter Russell Mead definition of a Jacksonian.

PPS: do you think my earlier what-if – of removing state monopolies, tort reform, FDA reform, would have been beneficial &/or possible?

A mark always believes he’s smarter than the con man. That’s what makes him a mark.

I’m pretty sure the reason Trump brought Bannon on was so he could hit both parties hard, and that his project for the next two years is beating the GOP into submission.

I’ve been right about Trump a lot, I’ve been able to predict at least some of his moves, which puts me ahead of a lot of people. Unfortunately that STILL counts for nothing.

#42 Comment By Franklin Evans On November 30, 2016 @ 12:25 am

JG: honor to you for your service.

I’m bypassing your what-ifs on moral grounds. They are valid on their face, but it comes down to a choice the people must make.

Either we bow to the notion that capitalist competition is the priority, or we look at this in a very different light.

I was going to use national defense as my analogy. On second thought, public education works better. Either way, I dislike argument by analogy, so do please keep grains of salt handy.

Logically, an educated pool of workers is vastly superior to an uneducated one. I limit my logic here to basic skills. Higher education and specialized skills don’t fit the analogy. Grain of salt.

Logically, a healthy pool of workers, whose ongoing health cannot be a burden to employers (let alone society-at-large), is vastly superior to the uncertainties of life affecting their ability to work.

The original model (caveat: long since faded into triviality) of public education was a simple formula. Everyone contributed to the cost of education, regardless of their personal benefit from it. It was the ultimate economy of scale. Indeed, education theory labels the early institution as the assembly line model.

If everyone must contribute to the cost of health care — and here the analogy admittedly begins to break down a bit — the economy of scale is obvious.

The basic foundation of insurance of any kind is a sort of economy of scale. I’ll skip a few thousand words needed to explain actuarial concepts, but the first one is simple. You define a risk pool (people, cohort), you calculate as best you can (statistical analysis) the probable expenditures for claims, and divide it across the pool. The early “assurance” programs, notably around firefighting, are the simplest example. Every home owner pays in, no one wants to need the service, but it’s paid for if it is needed.

Here’s the other side of the analogy. If your house catches fire, and you didn’t pay in, you either paid the cost of the firefighting or your house burned down to the ground (and your neighbors who did pay get their houses served).

That’s the harsh reality, and it informs (doesn’t rise to the level of analogy) the health insurance model. People have died because they lacked coverage and didn’t seek it out. No provider would ethically turn such people away, but if they can’t pay for their service they go bankrupt. If there’s charity behind it, so much the better… but in the end, is it really moral to leave it all to that progression when we have so many examples — those countries in Europe — showing how it can be done better?

As for the quality incentive out of competition, it fails completely for health care. It is not the only incentive, nor the best one. Have a conversation with a nurse or physician. The vast majority of them want to provide the best, most successful care they can to their patients, and how much they make has no bearing on that desire.

I know this is very long, but there’s another point I must make. People rarely sit down and really try to understand the dynamics of health care delivery and its costs. It starts with the education and training of care providers, continues throughout their careers as the science and technology advances. There’s the infrastructure of it all, from the smallest implement to the most complex machine, the buildings and their designs. Paying the care providers seems to be the only aspect of cost that people want to think about. Some people recognize the ongoing costs of supplies and drugs. Finally, there’s all the people and infrastructures for pharmaceutical companies, suppliers, transportation (not just ambulances)…

Designing a universal health care system is a huge undertaking. We must do it, and we have abundant precedent for it.

#43 Comment By Siarlys Jenkins On November 30, 2016 @ 10:14 pm

He had enough discernment to get elected against all odds.

Discernment? Look who he ran against. The hallmark of this election was the huge numbers of voters looking at which candidate they could hold their nose and vote for. From the looks of his cabinet proposals, those who thought he would be a great champion of the working class are going to feel badly burned soon. The DNC has only itself to blame that they couldn’t back a candidate who looked any more like a great champion of the working class than a bankrupt billionaire.

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